Professional Documents
Culture Documents
Delusions in Context 1st ed. Edition Lisa Bortolotti full chapter instant download
Delusions in Context 1st ed. Edition Lisa Bortolotti full chapter instant download
Edition
Lisa Bortolotti
Visit to download the full and correct content document:
https://ebookmass.com/product/delusions-in-context-1st-ed-edition-lisa-bortolotti/
More products digital (pdf, epub, mobi) instant
download maybe you interests ...
https://ebookmass.com/product/statistics-in-context-1st-edition-
barbara-blatchley/
https://ebookmass.com/product/delusions-of-competence-1st-
edition-robin-pearson/
https://ebookmass.com/product/theatre-in-the-context-of-the-
yugoslav-wars-1st-ed-edition-jana-dolecki/
https://ebookmass.com/product/human-trafficking-in-conflict-
context-causes-and-the-military-1st-ed-edition-julia-
muraszkiewicz/
Ecodramaturgies: Theatre, Performance and Climate
Change 1st ed. Edition Lisa Woynarski
https://ebookmass.com/product/ecodramaturgies-theatre-
performance-and-climate-change-1st-ed-edition-lisa-woynarski/
https://ebookmass.com/product/popular-high-culture-in-italian-
media-1950-1970-mona-lisa-covergirl-1st-ed-edition-emma-barron/
https://ebookmass.com/product/cypriot-nationalisms-in-context-
history-identity-and-politics-1st-ed-edition-thekla-kyritsi/
https://ebookmass.com/product/international-flows-in-the-belt-
and-road-initiative-context-business-people-history-and-
geography-1st-ed-edition-hing-kai-chan/
https://ebookmass.com/product/harmony-in-context-3rd-edition-
miguel-roig-francoli/
Delusions
in Context
Edited by
Lisa Bortolotti
Delusions in Context
Lisa Bortolotti
Editor
Delusions in Context
Editor
Lisa Bortolotti
Philosophy Department and Institute for Mental Health
University of Birmingham
Birmingham, UK
© The Editor(s) (if applicable) and The Author(s), under exclusive licence to Springer
International Publishing AG, part of Springer Nature 2018
Open Access This book is licensed under the terms of the Creative Commons Attribution
4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits
use, sharing, adaptation, distribution and reproduction in any medium or format, as long as
you give appropriate credit to the original author(s) and the source, provide a link to the
Creative Commons license and indicate if changes were made.
The images or other third party material in this book are included in the book’s Creative
Commons license, unless indicated otherwise in a credit line to the material. If material is not
included in the book’s Creative Commons license and your intended use is not permitted by
statutory regulation or exceeds the permitted use, you will need to obtain permission directly
from the copyright holder.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specific statement, that such names are
exempt from the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information
in this book are believed to be true and accurate at the date of publication. Neither the pub-
lisher nor the authors or the editors give a warranty, express or implied, with respect to the
material contained herein or for any errors or omissions that may have been made. The
publisher remains neutral with regard to jurisdictional claims in published maps and institu-
tional affiliations.
This Palgrave Macmillan imprint is published by the registered company Springer Nature
Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
Preface
This book gathers some influential views about the relationship between
delusional and non-delusional beliefs, and seeks to provide the resources
for a better understanding of delusions by considering the clinical, psycho-
logical, philosophical, social, and cultural context in which delusional
beliefs are adopted and maintained.
The views defended in the four self-standing chapters comprising this
book come from experts in different disciplinary areas and reflect a variety
of perspectives on the study of delusions and mental health in general,
encompassing lived experience, psychology, philosophy, and cognitive
neuropsychiatry. The contributors powerfully converge in describing
delusions as beliefs that share some of their characteristics with non-
delusional beliefs, all the while acknowledging that the concept belief
needs to undergo some significant revision in order to capture the relevant
features of human psychology. Notwithstanding some differences in
emphasis, Rachel Upthegrove, Richard Bentall, Philip Corlett, and I com-
mit to the thesis that there is significant continuity between delusional and
non-delusional beliefs, and defend the importance of examining delusions
in the context in which they emerge.
One thought that echoes in the four chapters is that, for all the effort
that has been made in providing a satisfactory definition of delusion, key
features of delusions can be found in many beliefs that we do not usually
regard as symptoms of mental distress. There are some examples of this
thesis throughout the book. In Chap. 1, Rachel Upthegrove and her co-
author S.A. write that “outside of mental illness, beliefs in God, aliens,
political ideologies etc. can be equally fixed, if not more so, on less
v
vi PREFACE
and funded by the European Research Council that I have the privilege to
lead. It is thanks to the generous support of PERFECT that I had the
opportunity to meet Rachel, Philip, and Richard and exchange some ideas
with them, after following and admiring their work for years. The project
has also enabled me to take the time to conceive of the present volume as
a means of continuing our exchange and inviting others to join the
conversation.
I hope you will see Delusions in Context as evidence that we need open
dialogue and genuine collaboration between experts from different disci-
plines and with different interests and perspectives in order to turn one of
the mind’s most fascinating mysteries, the adoption and maintenance of
delusional beliefs, into a tractable problem, and help people whose lives
are disrupted by delusions along the way.
ix
x CONTENTS
Index 117
List of Figures
xi
CHAPTER 1
Abstract Delusional beliefs are key symptoms of mental illness, and phy-
sicians over hundreds of years have attempted to understand and offer
treatments for patients with such beliefs. In this chapter, the authors will
explore the experience of delusional beliefs within the clinical context: i.e.
with people who present to mental health services for help. The authors
begin with definition of the descriptive psychopathology, prevalence and
context in which delusional beliefs occur and their clinical relevance.
Delusional beliefs have a core role in distress, depression and risk within
R. Upthegrove (*)
Institute for Mental Health, University of Birmingham, Birmingham, UK
Birmingham Early Intervention Service, Birmingham, UK
e-mail: R.Upthegrove@bham.ac.uk
S. A.
Institute for Mental Health, University of Birmingham, Birmingham, UK
psychosis. Real examples will be used to reflect on both the form delu-
sional beliefs take and their personal content, concluding with treatment
options and challenges.
It is said that even Mother Teresa doubted her faith, yet her religious beliefs
directly influenced her charitable actions. Unlike Mother Teresa, my delu-
sions had no room for doubt. I was convinced there was a “Challenge”
which placed me at the centre of an elaborate scheme to test my suitability
for university. “The Challenge” consumed my every being. As part of it I
believed people were recording every thought and every word I spoke. I
believed that food and drink were poisonous, which led me to not eating or
drinking for four days. Unlike Mother Teresa, there was no good in my
belief systems: only terror, anguish and exhaustion.
I was relieved that medication reduced the intensity of my experiences
over time. My delusional beliefs eventually subsided, after which I felt an
incredible sense of loss that things I concretely experienced were in fact my
mind’s creation.
I never want to face the horror of a delusion state again, and fortunately
I have received mostly excellent care from psychiatric services. Without
treatment, I wouldn’t have been able to go back to leading a “normal” life
and certainly wouldn’t be training as a Clinical Psychologist. My personal
and clinical experience makes me believe delusions are distinct from other,
more helpful beliefs, and it is inhumane not to offer people evidence-based
treatments for them.
This is not a sustainable situation and medicine has this need for action in
response to pain and suffering at its core. In the absence of risk or help
seeking, psychiatrists and other doctors are not ‘thought police’ and could
not enforce contact or treatment. This is not to deny the abuse of medi-
cine, and psychiatry as a branch of medicine, in darker periods of history;
in Soviet countries in the 20th century amongst other examples. Medicine
and psychiatry sit within, and are part of, society. It is our social structure
and cultural framework that gives context to what defines what are bizarre
versus acceptable beliefs. It is thus very evident that we should never lose
help-seeking and alleviation of distress or risk as the cornerstone for a psy-
chiatrist’s role in treating delusions.
Andrew walks in to the clinic, clutching a carrier bag, beaming. Despite his
many personal challenges, depression has never been a feature of Andrew’s
presentation. Today however, he is positively upbeat and clearly desperate to
show me what is in the bag. ‘I’ve got it doc, I’ve got proof! Once you see
this you will know I am a psychic’. Andrew produces a slightly dog-eared
certificate, issued by one of the growing 24-hour psychic TV channels, cer-
tifying that he is a Medium. Andrew has paid £1000 for this, and with fur-
ther investment he tells me he will be allowed to receive live calls from the
public for telepathic readings. Andrew believes that his talents have brought
him to the attention of MI5 and the CIA, who are working together to put
him through psychic training by ‘telepathically torturing’ him until an unde-
fined point in the future, when he will have passed their initiation, and
become a member of an elite telepathic spy ring. His feels this job on TV
will keep him busy until this day, and his destiny is revealed. His beliefs have
been firm for nearly 5 years. The torture he experiences takes place by way
of the secret services moving various organs in his body, with a considerable
amount of perceived pain, and by them inducing sensations in his rectum
and bowels of being raped, together with many voices and tactile hallucina-
tions of being punched, touched and at times even tickled.
Like the back pay from his disability benefits payment, Andrew uses his
latest piece of evidence to reinforce his beliefs and with a kind, benevolent
disposition takes the clinical teams continued non-committed response as a
further sign that the conspiracy is indeed well hidden. We are mere pawns in
the bigger game.
later delusions about being analysed and controlled by others arose from
this feeling of something being different, and was a way of my brain trying
to explain it.
have other poor outcomes and lower functioning (Reniers et al., 2017).
However the point here is firstly that it is proposed that delusions may
exist on a continuum and that positive symptoms are conceptualized
together, frequently co-occurring. Their sum total is more than the indi-
vidual experience of one in isolation, but may not be the most relevant
feature of how one functions in the world.
Cornblatt and colleagues propose a dimension of UHR status that has
an underlying vulnerability for positive psychotic symptoms driven to clin-
ical significance by cognitive deficits, mood disturbances, social isolation,
and school failure (Cornblatt et al., 2003). An alternative approach to
recognizing developing psychosis before frank delusions are present has
been proposed within the European tradition of Basic Symptoms.
Schultze-Lutter and Ruhrmann developed UHR criteria based on basic
symptoms as a complement to attenuated positive symptoms, and this aids
predictive validity of psychosis risk (Schultze-Lutter, Ruhrmann, Berning,
Maier, & Klosterkötter, 2008). Basic symptoms are subtle, sub-clinical
self-experiences such as disturbances in drive, stress tolerance, attention,
thinking, speech, perception and motor action. First described by Huber,
they are based in the subjective understanding of difference from a ‘nor-
mal’ self (Huber & Gross, 1989). Ruhrmann proposes that basic symp-
toms are compensated for by increasing effort, not available to observation
from others, and are recognized by an individual as a product of their own
mind (Schultze-Lutter, Klosterkötter, & Ruhrmann, 2014). With rele-
vance to delusions, cognitive basic symptoms include disturbances in
thought processing such as thought blockages, perseveration and pres-
sure. Broome demonstrated individuals at high risk of psychosis were
more likely to jump to conclusions (JTC) on the basis of less information
when cognitive demands are high (Broome et al., 2007). Subjects at high
risk of psychosis and controls completed a bead-jar task, where by deci-
sions on which of two jars with different numbers of coloured beads are
made when a varying number of beads are shown. A JTC bias is seen when
subjects make a decision about which jar on fewer number of beads. When
involved in an additional working memory task, subjects with high levels
of delusional like thinking were more likely to show a jumping to conclu-
sions bias. Thus the primary cognitive difficulty or working memory was
managed by decision-making at an earlier stage. A subtle compensatory
response to basic cognitive disturbance demonstrates that even at the first
delusional belief formation stage, the influence of other ‘symptoms’ or
processes are key (Garety & Freeman, 1999).
Another random document with
no related content on Scribd:
esclaves guident ses pas chancelans, l'or de ses habits semble le
disputer à l'éclat du soleil, il s'avance lentement. Que vois-je? des
yeux glacés qui regardent avec froideur les beautés de la nature, une
physionomie flétrie où regnent l'orgueil & le mépris insultant. Il voit le
soleil se coucher derriere les montagnes & darder ses rayons
enflammés à travers un nuage épais, & ce spectacle brillant ne fait
aucune impression sur son ame. Les ombres descendent
majestueusement du sommet des montagnes, un calme sacré
s'étend sur toute la nature, le rossignol remplit le vallon de sa voix
touchante, un ruisseau fuit en murmurant entre les fleurs d'une
prairie & les arbrisseaux d'un bosquet touffu. Le riche n'a rien vu; il
foule dédaigneusement: les fleurs de la prairie, il court s'enfermer
dans ces édifices qu'il a décorés du beau nom de maisons de
campagne, & s'y plonger dans les vices que l'habitude lui a rendus
nécessaires. L'aurore aura déjà déployé le bonheur sur toute la
nature, que le riche sera encore enseveli dans la molle dépouille des
cygnes; & des barrieres multipliées défendront sa retraite contre les
premiers rayons du soleil.
Mais faut-il que la foudre écrase les villes? faut-il que l'édifice
immense de la société s'écroule tout d'un coup pour te convaincre de
ton injustice? Non, non, mille accidens peuvent détruire l'illusion de
ta prétendue grandeur & te découvrir ton néant. Tu peux perdre en
un instant tous ces biens étrangers qui font l'objet de ta vanité; un
conquérant peut t'en dépouiller, & t'envoyer avec d'autres hommes
peupler des contrées désertes. C'est alors que tu verras les hommes
qui ont appris dès leur enfance à être utiles à leurs semblables, tenir
le premier rang dans la société naturelle; c'est alors que, ramené à
l'état de nature, tu sentiras que tu es le dernier de tous les êtres,
parce que tu es le moins utile.
Il est des riches que les préjugés & les passions n'ont pas
entiérement endurcis, un triple airain n'a pas encore fermé leur cœur
à toutes les impressions des plaisirs innocens, & la nature sourit
quelquefois à leurs sens émus. Dès que les neiges coulent en torrent
du haut des montagnes, pour faire place à la verdure, dès que la
terre offre les appas séduisans des fleurs au Zéphyr qui la
renouvelle; ils sentent renaître, dans leur cœur, le germe du bonheur
qui leur étoit destiné; ils volent dans nos Campagnes; ils tressaillent
à la vue de leurs beautés; & ils croient avoir trouvé le bonheur. Mais
ce plaisir qui n'étoit qu'une invitation de la nature, se dissipe bientôt.
Ils dédaignent de mettre la main au râteau & à la bêche, ils sont trop
foibles pour se courber sur la charrue, & ils ne veulent pas mériter la
gaieté vive des moissonneurs qui, après avoir supporté la chaleur du
jour, vuident en chantant une cruche de cidre rafraîchissante qu'ils se
passent à la ronde, ou se reposent à demi-nus sous le feuillage
épais d'un orme bienfaisant. Le dégoût & l'ennui les rappellent
bientôt à la ville, ils se replongent dans le tourbillon de leurs faux
plaisirs, & méprisent la Campagne dont ils ne savent pas jouir.
Homme vain & superficiel, fuis à jamais de ces lieux fortunés, ils
ne sont faits que pour les ames qui en sentent tout le prix; mais du
moins ne les méprises pas sans les connoître. Arrête un instant tes
regards sur ce champ où croît le blé qui va te nourrir, considere ce
côteau où la nature mûrit en silence la liqueur vermeille où tu
puiseras l'oubli de tes maux; vois ton semblable courbé sous le poids
des années, s'avancer lentement sur cette montagne escarpée, &
employer le reste de ses forces à relever les branches de la vigne.
Considere un instant ce spectacle; frémis de ton inutilité & de ton
ingratitude, & apprends à respecter des lieux sacrés où toi seul es un
profane.
Lorsque Lucette fut entiérement rétablie, son pere lui dit un jour:
Ma fille, tu commences aujourd'hui ta dix-huitieme année, allons
visiter les arbres que je plantai le jour de ta naissance, & remercier le
ciel qui n'a pas permis que tu me sois enlevée. Ils arriverent vers les
ormeaux; Licidas, par les ordres de Palémon, avoit conduit son
troupeau dans le même endroit. Viens, Licidas, lui dit le vieillard,
viens recevoir le prix de ta bonne action. Tu as sauvé la vie à
Lucette, elle te donne cette prairie que tu vois devant toi. Je la lui
donnai le jour de sa naissance. N'est-ce pas, Lucette, dit le vieillard
en sonriant à sa fille, tu veux bien y consentir? Les deux amans
étoient tremblans, ils s'étoient attendus à une autre récompense. Ma
fille vient de te témoigner sa reconnoissance, poursuit le vieillard,
mais je ne t'ai pas encore témoigné la mienne. Tu m'as rendu le plus
grand service que son puisse rendre à un pere. Sans toi, je
mouillerois mon pain de mes larmes, & ma voix tremblante
demanderoit ma fille à tous les échos de la contrée; sans toi, j'aurois
fini ma vie, sans jouir de ses derniers embrassemens. Prends, mon
ami; prends ce que j'ai de plus cher, prends cette fille que tu m'as
rendue, je te la donne pour épouse. En disant ces mots, le vieillard
mit la main de sa fille dans celle de Licidas, puis il les pressa tous
deux contre son sein; en même temps des sanglots s'échapperent
de sa poitrine, & des larmes coulerent le long de ses joues. Les
amans pleuroient aussi; ils prenoient les mains du vieillard & les
couvroient de baisers & de larmes. Ils étoient tous trois heureux.
Mais le vieillard l'étoit encore plus que ses enfans. Leur bonheur étoit
son ouvrage.
S E C O N D E N U I T.
D i e u .
Placé comme un point sur ce globe qui n'est lui-même qu'un point
imperceptible dans l'immensité de l'univers, l'homme se demande à
lui-même: Que suis-je? où suis-je? d'où suis-je venu? Il se regarde
avec curiosité, se touche avec étonnement. Il regarde, il touche tout
ce qui se trouve à sa portée. Il sent qu'il existe, il sent qu'il y a
d'autres êtres qui existent hors de lui; mais tout le reste n'est pour lui
qu'obscurité & ténebres. Il jette de tous côtés ses regards étonnés &
incertains, une multitude d'apparences qui varient au gré de la
lumiere & des vents semblent se jouer à chaque instant de sa
crédulité. Il leve les yeux, l'éclat du soleil l'éblouit, l'immensité des
cieux l'effraie, & ses regards découragés retombent sur la terre.
Il est heureux, & il ne connoît encore que la plus petite partie des
plaisirs qui lui sont destinés. Quels seront les transports de sa joie &
de sa reconnoissance, lorsque son cœur s'ouvrira pour la premiere
fois au doux besoin de l'amour & de l'amitié; lorsque la tendresse
paternelle fera tressaillir ses entrailles; & qu'associé, pour ainsi dire,
à la puissance de son Dieu, il verra des êtres vivans qui lui devront
une partie de leur bonheur? Un être semblable à lui se présente à sa
vue. Saisi d'un trouble plus vif & plus délicieux que tout ce qu'il a
éprouvé jusqu'alors, il s'approche. C'est une compagne que le ciel lui
envoie. Elle répond au langage de ses yeux, elle partage les
transports qu'elle inspire. Leurs regards se confondent, leurs bras
s'entrelacent, ils sont enivrés des délices de l'amour.
Hélas! la nature & mon cœur m'avoient appris une partie des
choses que vous me dites, le reste me paroît obscur. Vous n'êtes
point d'accord sur les choses que vous m'annoncez, & vous me
menacez tous de la vengeance du ciel, si je refuse de vous croire.
Puis-je croire que Dieu se sert d'un langage obscur pour instruire une
créature foible & bornée? Le Dieu de la lumiere se manifeste-t-il
donc au milieu des ténebres? Le Dieu de toute bonté se joueroit-il de
ma foiblesse, en attachant mon salut éternel à des choses que je ne
puis comprendre?